Select a form below to submit a request related to Chiropractic services. For assistance with healthcare information managed by other Optum areas such as Behavioral Health, Interactions with an Optum Nurse, OptumRx Home Delivery Pharmacy, and/or Physical/Occupational Therapy, go to the “Forms” page and select the appropriate area.
If you are unable to find the form you need or have questions, call the phone number on the back of your health plan ID card.
What would you like to do?
- I’d like to request a copy my healthcare information maintained by Optum. Click here to submit a request.
- I’d like to change my address, phone number or billing information associated with my account. Do not complete a form through this site. Call customer service at the telephone number located on your health plan ID card or your employer group, or update the information through your online account (where applicable).
- I’d like to request an amendment or correction of my healthcare information maintained by Optum. Click here to submit a request.
I’d like to request communications of my healthcare information be sent to an alternative location because I have concerns about my safety (known as a confidential communication), or I’d like to change or remove a prior request.
Click here to submit a request.
- I’d like to request a list of who my healthcare information has been released to for purposes outside of treatment, payment, or healthcare operations. Click here to submit a request.
I believe that my privacy rights have been violated and I’d like to file a complaint. We will not take any action against you for filing a complaint.
I’d like to obtain a copy of the Notice of Privacy Practices (NPP) outlining how my healthcare information may be used and/or disclosed.
- If you are enrolled in an insured plan offered by Optum Physical Health, click here.
- If you are enrolled in an insured plan offered by Optum Physical Health of California, click here..
- For all others, contact your plan directly.